Russell Westbrook injury: Q&A with NBA Head Team Physician

Jan 7, 2014; Salt Lake City, UT, USA; Oklahoma City Thunder point guard Russell Westbrook (0) reacts during the first half against the Utah Jazz at EnergySolutions Arena. Mandatory Credit: Russ Isabella-USA TODAY Sports

When we found out that Russell Westbrook was going to need a third surgery on his right knee in late December, every Thunder fan began to worry.

No matter how minor the procedure may be, three surgeries couldn’t be a good thing and it was definitely cause for concern.

To help shed some light on Westbrook’s situation, we at Thunderous Intentions were able to interview Dr. Riley J. Williams, Head Team Physician of the Brooklyn Nets and NY Red Bulls, and Orthopedic Surgeon at Hospital for Special Surgery.

Thunderous Intentions: What are some other NBA players in the past who have suffered the same type of knee injury that Russell Westbrook did? How did they recover?

Dr. Williams: Derrick Rose, Blake Griffin, Eric Bledsoe, Jeremy Lin, Chase Budinger and J.R. Smith all had meniscal surgeries in the recent past. These surgeries typically involve removing a small flap or portion of the meniscus that is torn. Unlike many parts of the body, the meniscus has a very poor blood supply. As a result, we surgeons are unable to “fix” or sew most meniscus problems. When the tear is near the edge or periphery of the meniscus, we can sometimes use suturing to fix a meniscus injury. However it is important to note that meniscus repairs have an expected healing rate of about 50-60% (just over half). This means that just under half the time, a meniscus repair procedure does not work. Still, it is worth trying to save the meniscus whenever possible because removing meniscus tissue can result in knee degeneration over the long-term.

Each of these players is in different stages of recovery. Derrick Rose and Eric Bledsoe are recently injured and are still in rehab. Jeremy Lin, Blake Griffin, and J.R. Smith were able to return to play without issue. Chase Budinger had a repair of the meniscus (like Westbrook) which did not hold. He has another surgery before this season and seems to be working his way back into shape for a return to play this season.

TI: When everyone hears the words “knee injury” they get scared. But obviously there are different levels of knee injuries and surgeries. Where does partially tearing your right meniscus rank in terms of severity of knee injuries that NBA players often suffer?

Dr.: Meniscus tears are very common in the NBA. Due to the nature of the game, player’s knees are subjected to high velocity stops and starts. This puts tremendous pressure on the menisci which act as natural shock absorbers to the healthy knee. Certainly all knee injuries could be described as serious, but a torn meniscus is typically an injury from which most Orthopedic Surgeons would expect a full recovery. There are issues with these knees over the mid to long term, but isolated meniscus tears do typically do well. Meniscal injuries are not considered as serious as say tears to the ACL (anterior cruciate ligament) or damage to the articular cartilage of the knee.

TI: Westbrook said he wasn’t playing through pain and therefore it seems like he is going to try and come back as soon as possible. Is it possible that even if he isn’t feeling pain, he should still need to remain off the court and recover longer to ensure a full recovery? What is the best way to recover?

Dr.: Each player/patient has a different pathway to a full recovery. I do not know the specifics of Russell’s issues following his initial surgery. It is not uncommon for patient to experience the onset of swelling following suturing procedures like the meniscus repair surgery that he had. A loose suture can be an irritant to the knee, and thus cause swelling. Such swelling may not cause much pain. I see this phenomena a lot in high level athletes who do pivoting sports (basketball, soccer, football, lacrosse). And though it is not my favorite thing to do, redoing a knee arthroscopy to take of such problems is the best way to ensure a full recovery.

It really is hard to say what the “best way” to recover is for any athlete. The biggest issue with high level athletes having surgery is maintaining fitness. It takes great strength and stamina to play professional basketball for 40+ minutes. As a result, once the operated knee feels good and athletes can run again, there is still a period of conditioning and fitness training that must occur to make the player “game-ready”. This post-medical-clearance interval varies from player to player.

TI: Does this injury leave Westbrook now to being more susceptible to future injuries? Could you see him having a full recovery in which this injury never has an impact on his future?

Dr: Again, as I do not know the exact nature of his injury, it is difficult for me to comment specifically on his future. However, I can say that I would expect him to be fine over the next several seasons, especially if he had no other injuries (such as articular cartilage damage) that occurred with the described meniscus tears. Most high demand athletes will experience some articular cartilage degeneration over time. The loss of the cushioning effect of the meniscus results in an increase in the loads on this cartilage. Over time this increase in load can cause cartilage to break down. I am not suggesting that Russell will have continuing knee problems, but we doctors are always vigilant about the possibility of such issues following meniscus surgery.

TI: My biggest worry about Westbrook is that given the way he plays, he puts more pressure on his joints, knees, etc. than most NBA players. This injury now has his right knee less capable of taking on the pressure he puts on it. So that’s why he developed swelling in it this season and this may be a recurring thing given the way he plays. Is this a reasonable concern that I have?

Dr.: I agree that Russell puts a high degree pressure on his joints compared to a lot of NBA players. From what I have observed, he is a high-energy, hyper-athletic backcourt player who uses his speed and movement to his advantage. This is typical of a large number of similar type players in the NBA. There is natural difference between big front court players and fleet-of-foot back court players. More speed and more lateral movement create increased forces on the internal structures of the knee….including the menisci. And right now, given where he is in his rehab, I agree that the right knee probably still needs time to strengthen so that he can resume play. But, given his athletic nature I am confident that he will effectively return to play once he gets the strength he needs to compete at his normal level.

TI: What can Westbrook do differently to prevent future injury?

Dr.: This is a tough question. Really there is little he can do to prevent another injury. Falls, twists, and impacts happen every game. Each one of these events is a potential injury waiting to happen. However, such injuries are an occupational hazard, and I don’t think most high level players really worry about such things in the flow of games and practices. The one thing he can do to decrease the likelihood of re-injury would be to really focus on his strength and fitness. Strong, leg and hip muscles provide protection to the inner structures of the knee and provide stamina for the demands put upon the NBA athlete’s legs during the course of the season.

We at Thunderous Intentions would like to thank Dr. Williams for taking the time to answer these questions.